Category Archives: pregnancy

In introducing this month’s Butterfy Effect theme of CONNECTING, I am honored to share an interview by the founder of Recovery Warriors, Jessica Raymond, MS. Recovery Warriors is a multimedia resource hub for hope and healing from an eating disorder. Here is a link to the podcast: RecoverywarriorsPodcast

An overview

The desire to become a mom can be a motivating factor in eating disorder recovery. However,the challenges of pregnancy and the postpartum period mirror the early stages of recovery. Both pregnant and new mothers and women recovering from eating disorders experience anxiety, body image distress, difficulty sleeping, hormonal changes, appetite changes, and ambivalence/excitement/distress around cultivating a new identity. In this episode of The Recovery Warrior Show, expert Dr. Linda Shanti shares personal and professional stories of recovering from an eating disorder and entering into motherhood. Listen in regardless of where you are at in the biological cycle because there is much to learn.

What You’ll Learn

Why people don’t talk about miscarriages

How pregnancy is similar to early stages of recovery

Why you need to be proactive in seeking professional help before having a baby?

Why how a mother eats affects her child

Is there a right time to have a kid

Favorite Quote

The moment a child is born, the mother is also born. She never existed before. The woman existed, but the mother, never. A mother is something absolutely new. -Bhagwan Shree Rajneesh

Advice to Former Self

You’ll get through this honey, you will. It’s going to change you and it is changing you and that’s ok; that’s the way it’s supposed to be. There’s no parallel life that you’re supposed to be leading; this is it, this is not a detour. Just because you’re suffering doesn’t mean you’re on the wrong path; you’re absolutely on the right path. Keep going.

Definition of Recovery

Taking care of yourself physically, emotionally, psychologically, and spiritually. Not engaging in behaviors that hurt me. Moving toward growth edges. Accepting my body as it is. Allowing and inviting all feelings. Lowering the bar on perfectionism. Thinking in the rainbow between black and white. Listening to my heart and connecting with a larger purpose.

“You must give birth to your visions. They are the future waiting to be born. Fear not the strangeness you feel. Just wait for the birth, for the hour of the new clarity. ” -Rainer Maria Rilke

Vision:

1. the act or power of seeing something with the eyes

2. the act or power of seeing or anticipating that which will or may come to be “prophetic vision, the vision of an entrepreneur”

Every year I make, and then facilitate others making, vision collages. What is a vision collage? It is just as it sounds- a collage of your vision. It is a visual representation of what you would like to live your way into. It can be as literal and/or non literal as you would like. It may include very specific items (a new car or job) or how you would like to feel (safe, loved, free from anxiety). I usually focus on the year ahead to ground it: What is your vision for the next year? However, the Soul works in its own way and its own timeline. There is a 12-step saying about spirituality, which goes like this: God has three answers: Yes; Yes, but not now; and No, I have something better in mind.

Yes:

Although this may sound easy, it isn’t always easy to live your way into the yes of your vision. I often think of vision collages as a map of where-you-will-arrive-after-clearing-the-obstacles-to-where-and-who-you-already-are. For example, four years ago, I put on my vision collage a brand new prius. That year, when my toyota corolla, (which had been going and going and going), died, I went to the car dealer and looked at possibilities. I looked at many cars, including brand new prius-es and another used toyota corolla. That night, when went home to think about it, sleep on it, and talk with financial advisors, I still couldn’t make up my mind. Finally, my husband who who had been talking about how much more long term financially feasible it would be to get the new prius when I was whining about “maybe I should just get another used corolla,” brought me over to my vision collage and said “IS THAT A COROLLA UP THERE OR A PRIUS?!” Suddenly, I realized it was my own fear of stepping into my vision that was the obstacle. The next day I got my prius.

Many years prior to the prius, I put a pregnant woman on my vision collage. At the time I was not in a romantic relationship and was a No-or-ambivalent-at-best on the question of having children. I didn’t even know if I could have children due to having an eating disorder and the possibility of damaging my fertility earlier in my life. I wasn’t sure why the pregnant lady appealed to me and appeared on my collage, but I went with the intuitive process of putting the image on there without needing to know what it meant. I thought this was more about birthing myself in recovery and my career, which was true at the time and did occur that year.

Yes, but not now:

However, many years later, the pregnancy became literal. I am now happily a mom when I thought I never in my wildest dreams thought I would be.

Another Yes,-but-not-now experience was putting “Licensure as a Clinical Psychologist” on my vision collages. All through working at substance abuse rehabs, eating disorder rehabs, hospitals, graduate school, pre-doc, finishing the dissertation process, post-doc, post-baby, post postponing the first licensure exam, post passing the first licensure exam, post starting a private practice, and FINALLY passing the second exam, this was on my vision collages. There were many times I lost faith in the process, but just kept putting 1 foot in front of the other toward the vision and finally manifested it.

I have something better (or different) in mind:

Even before the pregnant woman, a blue-eyed “ideal partner” was on my vision collage. This never came true. I was ok with that. My husband has crinkly brown eyes full of depth. I had actually forgotten this was even part of my vision until a friend and colleague pointed out years later that my child has beautiful blue eyes. When I realized that, tears came to mine because of the mysterious ways that spirit brings our visions true. I never would have imagined that I was to become a mom, nor that my “blue eyed partner” was going to be created inside of me from two brown eyed parents.

Just in case you think visions always come true in exactly the way you wish they would, here is what I had on my vision collage the year I was pregnant:

Well, he was comfy and dry for the most part, but “like a champion”is most definitely not how I would describe my baby’s sleep patterns the first year!

The next year I was a bit more realistic about affirming the shadow side, difficulties, and imperfections of mothering (while still loving the miracle and privilege of it).

I didn’t go to Hawaii that first year, but this year we are going as a family.

For 2014, I had “Recovery Mama’s” vision statement on my collage. It included guest blogging, creating affirmation cards for new moms, writing my book, and supporting moms recovering from eating disorders in my psychotherapy practice.

The book proposal is being edited, and stay tuned for my newly coming guest blog next month!

I feel truly blessed to work with the clients I see and witness their growth in recovery and motherhood. It is literally a labor of love and the work I feel called and honored to do.

What are your visions for 2015? There is no wrong way to make a vision collage. Sometimes people I work with use all words, sometimes they use all pictures, sometimes they use a board and sometimes colored paper. Often they will choose magazine images that speak to them intuitively that they don’t necessarily know why. And sometimes they will choose very specific images. One of my favorite quotes is from Meister Eckart and says:

“When the Soul wants to experience something she throws out an image in front of her and then steps into it.”

I remember going to my first ObGyn visit when I was pregnant. The Doctor put “AMA” in my chart. Having worked in treatment settings for eating disorder recovery for many years, I thought she meant “Against Medical Advice,” the term clinicians use when a client is choosing to leave treatment despite their providers’ recommendations. I quickly said to my Doctor:

“I just want you to know am willing to implement any medical advice that you give me regarding my pregnancy!”

She gave me a blank stare.

I explained that I noticed she had written “AMA.”

She smiled. That means “Advanced Maternal Age.”

“Oh.” Long pause. “Oh.”

Being a mother of “advanced maternal age” is becoming more and more common in developed nations, as women work toward completing higher education, solidifying their careers, finding the right partner, and doing personal growth work prior to having children. The Center for Disease Control and Prevention reports:

Delayed childbearing in the United States is evident in the 3.6-year increase in the average age at first birth between 1970 and 2006…The dramatic increase in women having their first birth at the age of 35 years and over has played the largest role in the increased average age of first-time mothers…many other developed nations have observed increases in average age at first birth with some now averaging near 30.0 years of age. 1

What does this phenomena have to do with disordered eating and body image?

Although data regarding body image in middle aged and older women remains sparse, a study published just this past month in the International Journal of Eating Disorders suggests that body dissatisfaction and drive for thinness do not diminish with age. In a survey of 715 women just out, of which 76.5% were married with children, 4.6% met full diagnostic criteria for an Eating Disorder and 4.8% met criteria for Subthreshold Eating Disorder (SED). 2 Together, that makes roughly 10%. So that means 71 of those women with children are suffering with disordered eating.

There is a reason why the myth that eating disorders affect young women in adolescence exists. According to the National Association of Anorexia and Associated Disorders (ANAD): Over one-half of teenage girls…use unhealthy weight control behaviors such as skipping meals, fasting, smoking cigarettes, vomiting, and taking laxatives.3 Adolescence is a huge rite of passage for a woman. When a rite of passage is not celebrated, ritualized, or supported, the growth required to complete crossing the threshold of this rite of passage goes underground. Mary Pipher, author of Reviving Ophelia: Saving the Selves of Adolescent Girls (2005), writes:

“I think anorexia is a metaphor. It is a young woman’s statement that she will become what the culture asks of its women, which is that they be thin and nonthreatening…Anorexic women signal with their bodies “I will take up only a small amount of space. I won’t get in the way.” They signal, “I won’t be intimidating or threatening. (Who is afraid of a seventy-pound adult?)” 4

Similar to adolescence, both parenting and middle age are rites of passage in a woman’s life. When not honored, seen, and embraced, these can also turn into eating disorders and body image distress. Ageing women also face the cultural taboos of not taking up too much space, speaking too loudly, or being seen and valued. They face the task of loving themselves and embracing aspects of the beauty of mortality, power, and wisdom that western media culture is terrified of in women: wrinkles, thick middles, saggy boobs, gray hair. I remember reading one article on “objectification theory” in my doctoral research that linked media and female body image obsession with western culture’s fear of mortality. Female body objectification may veil unconscious existential fears. 5 Other stress factors that affect women in middle age that are similar to adolescence are hormonal changes. However, middle age women also face different stressors such as: medical scares, death of a parent or a spouse, divorce, and career challenges. 6 Margo Maine, co-author of The Body Myth: Adult Women and the Pressure to be Perfect, writes:

Women in their 30s, 40s and beyond face increasing pressure to look slender and youthful despite years of childbearing, hormonal changes at menopause and the demands of careers, parenting and caring for aging relatives…Some researchers call it the ‘Desperate Housewives effect,’ referring to the cultural influence of the hit TV series, in which improbably thin women in their 40s prance around in short shorts. 7

It is an interesting journey being “advanced maternal age.” Sometimes I look at young(er) women or young(er) mothers and I think You look so not tired. Or Wow your stomach looks so not stretched. I remember that. That feels like a long time ago. Or I envy younger moms who are more likely to have their grandparents be present for their children’s growing up. My child will already never meet one of his Grandpas. He died before my baby was born. However, there are gifts I have being “middle aged” that I couldn’t have come by earlier in my journey. I had not yet solidified my eating disorder recovery in my twenties. I had not earned a doctoral degree in Psychology in my twenties. I had lots of ideas and lots of difficulty with follow-through. I thought being earnest would pay the rent. The concept of income needing to match or be greater than outgoing expenditures was not a concept I truly understood or felt applied to me. Because I now have financial clarity, I don’t have to “deprive,” “restrict” or “binge” or “purge” with money, like I used to do with food in my twenties. Interestingly, though I hated my (flatter) stomach in my twenties, I now love my (stretched) stomach in my early middle age. I also have much more capacity to pause and come back to difficult interactions in relationships rather than avoid, hide, or leave. I would not have been ready for marriage in my twenties. I would not have had the “distress tolerance” skills to go toward a young child and stay emotionally present through individuation-attempting tantrums. I would have been inadvertently shaming or stuffed the discomfort with food. I can tolerate it now. I would not have been a good, or frankly even good-enough, mother in my twenties. I wasn’t ready. I remember studying for the Psychologist licensure exam learning that the executive function of the brain (the part that fully understand cause and effect and is able to therefore pause impulsive actions) is not fully developed until the late twenties, or even 30. Does that mean all women should only have children after age 35? Or that only women over 35 are good (enough) mothers? Of course not. And not all women are able to. One always has the potential to become a good (enough) mother. In fact, the eating disorder recovery process mirrors the journey of becoming a good enough mother to one’s self: allowing and embracing imperfection, listening to and honoring emotions, communicating clearly, getting enough sleep, eating in a balanced way, practicing mindfulness or spirituality, connecting with support. And THAT is always possible and always a work-in-process, regardless of one’s chronological age.

Dr. Linda Shanti McCabe is a Mom and Licensed Clinical Psychologist who works with women recovering from Eating Disorders, Body image difficulty, Depression/Anxiety, Perinatal Mood Disorders, and New Mommy “boot camp.”You can read about her work professionally at www.drlindashanti.com

Resources:

1. T.J. Mathews, T.J. and Brady E. Hamilton, “Delayed Childbearing: More Women Are Having Their First Child Later in Life,” Center for Disease Control NCHS Data Brief, Number 21, August 2009. http://www.cdc.gov/nchs/data/databriefs/db21.htm

This is my son’s belly. He is very proud of it. He is also proud of his poo and pee. He lives in a shame free land (so far). I will protect him from shame for as long as I can. He is in Erikson’s “Shame vs Doubt” stage exploring the question “Is it ok to be me?” He happily runs around, showing off his belly, exploring this question. I will fiercely fight for him to hold onto the truth that lives in his belly that it is not only ok but ESSENTIAL that he be himself.

I remember 15 years ago very early in my eating disorder recovery thinking in the midst of horrible body image distress “My belly is so fat- it looks like it is pregnant!” It wasn’t pregnant- it was full of shame, anger and unexpressed emotions. It was FAT: Feeling Are Thick. It was also nowhere near the size of a pregnant belly, having lived the reality, I now know. If I were to talk to my younger self now, I would say, with great compassion and fierceness, “Honey, you are nowhere near to having a pregnant belly. You want to see a pregnant belly? HERE. Now. What is in there that needs to be birthed and expressed? Get it out because it is not only ok but ESSENTIAL to your recovery and your life that you be yourself.” My older self has learned that. And my belly is now (mostly) free from shame and anger having receivied many apology letters for how I abused it and having been listened to much more frequently over the past decade and a half.

I’m not going to say it wasn’t difficult with body image postpartum (see “Dear New Mama” and “Does being a Mommy make me look fat?” previous posts). However, I AM proud of my Mama belly. I grew a child in there. Yes, my belly looks different in a bathing suit because I GREW A CHILD in there. Wow. That is pretty miraculous. Thank you belly.

A friend of mine sent me this video postpartum. It is well worth watching the celebration of a woman’s body and belly.

I distinctly remember 1 moment postpartum when my husband and I were in a bookstore, with baby in the carrier, browsing. I saw the book The Female Brain and picked it up, thumbing directly to the section on “Mommy brain,” and, more specifically, “Breast feeding and the Fuzzy brain.” I was still breast-feeding, fuzzy brained, and seeking some scientific proof that I wasn’t going crazy. I found it. Louann Brizendine, MD writes:

“…one down side of breast feeding can be a lack of mental focus. Although a fuzzy brained state is pretty common after giving birth, breast feeding can heighten and prolong this mellow… unfocused state…the parts of the brain responsible for focus and concentration are preoccupied with protecting and tracking the newborn.”

During this time, I would walk into the next room of the house to get something and forget what it was. Keys? Diaper bag? One of my husband’s friends, a Stanford scientist with two children, explained: “You’re breastfeeding. Your brain will come back after you stop.” This fuzzy breastfeeding brain also explained why I felt physically connected with my baby when I went back to work. Brizendine writes:

Many mothers suffer ‘withdrawal’ symptoms when they’re physically separated from their babies, feeling fear, anxiety, and even waves of panic. It is now recognized that this is more than a psychological state but is a neurochemical state.

The longer and more often a baby suckles, the more it triggers the prolactin-oxytocin response in the mommy brain…Oxytocin dilates blood vessels in the mother’s chest, warming her nursing child, who also gets doses of feel good compounds in the breast milk…

Ah, Oxytocin, the bonding hormone. By 3:00pm at work, I would be physically and emotionally longing for my baby. I’m sure it was no accident that this was the time that I would pump milk for him and he would be having his afternoon snack! I remember coming home from work, checking in with the nanny on how baby’s day went, and she would say “he’s probably not hungry- just had a bottle about an hour ago.” I would nod ok, and then, as soon as she left, baby would lunge for the breast like a long lost lover and Mama would feel relieved and reconnected.

According to Brizendine, This lovely, feel-good state of oxytocin is turned on at the time of birth.

The mommy-brain transformation gets underway at conception and can take over even the most career oriented woman’s circuits…At the same time, her brain signals for eating, especially in the morning, become finicky as her brain is changing how it reacts to certain smells…she wouldn’t want to eat something that would harm her fragile fetus…That is why her brain is now overly sensitive to smell.…Progesterone spikes from ten to a hundred times its normal level … and the brain becomes marinated in this hormone, whose sedating effects are similar to Valium.

Pregnancy brain

I wish I had had this book when pregnant. Sometimes there is no substitute for empirical, neurological data to combat shame and confusion. I remember sitting at my desk at work while pregnant feeling like I was in a mental fog and wondering where my focus had gone? Where was my motivation for work? I would sit there feeling like a hippo (I know, hippo is not a feeling- see previous blog), daydream about rocking chairs, and eat olives with hummus and crackers (My baby had a Greek craving theme). I could not tolerate perfume smells and threw up in the airport when walking through the fancy shopping section filled with expensive scents.

I was also studying psychological material for the EPPP (Examination for the Professional Practice of Psychology: the licensure test for Psychologists) at the time, and confused about why nothing I was studying seemed to be able to stick in my brain. I would study material and then the next day it would have flown out of my mind. This was not very pleasant or ego syntonic for someone who had earned 4.0’s all through her undergraduate, Master’s and Doctorate degrees. At 7 months pregnant, I was scoring 50% on practice exams. Finally, with humility, resignation, some resistance, and a good dose of radical acceptance, I threw in the towel and postponed.

Why have 9,000 books have been written about

helping your baby sleep through the night

While oxytocin is a lovely feel-good chemical, drops in hormone levels mixed with lack of sleep do NOT feel good. I remember a mother in my brand New Mommy group telling me about how her baby slept through the night at 3 months. Bless her for her kindness (or perhaps it was discernment that the other mothers may have killed her) for not sharing this at the time. Every baby, like every person, has their own temperament, their own capacities, and their own preferences from the time of birth. I see this in my own child, a boy, who seems to be predisposed to fire trucks, dump trucks, dinosaurs, and things that go bang or boom. As a feminist, I would have ardently fought this Nature-Nurture debate prior to children. However, my little boy is naturally drawn to trucks, particularly those that dump things or make loud noises. Anyway, that is a whole other post (See http://www.scarymommy.com/boys-vs-girls/)

My baby did not naturally sleep through the night at 3 months, 6 months, 9 months, or 12 months. That too, is a whole other post as well as bookshelves filled with thousand of experts offering their advice on how to get one’s baby to sleep. For the new Mom, though, lack of sleep can contribute to a fuzzy brain.

In a new mother, sleep is disrupted by repeated awakenings of the infant, but hormonal factors also seem to play a role. Immediately after childbirth, levels of the reproductive hormones, estrogen and progesterone, drop precipitously. It is believed that, because these hormones modulate neurotransmitter systems in the brain responsible for sleep quality, this dramatic hormonal shift may cause significant disruptions in sleep. (See MGH Center for Women’s Mental Health http://www.womensmentalhealth.org/posts/postpartum-depression-and-poor-sleep-quality-occur-together/ )

I remember going into work and hearing my (childless) co-workers say, “Gosh, I’m tired today.” Then they would sheepishly look over at me a moment later and say “Oops sorry” as I gave them the death stare. However, sleep-deprived states aside, there are other brain changes that can occur postpartum that are both beneficial and astounding.

Does the brain grow BIGGER postpartum?

Research from the American Psychological Association suggests this is the case.

Exploratory research…found that the brains of new mothers bulked up in areas linked to motivation and behavior…A comparison of images taken two to four weeks and three to four months after [new mothers] gave birth showed that gray matter volume increased by a small but significant amount in various parts of the brain. In adults, gray matter volume doesn’t ordinarily change over a few months without significant learning, brain injury or illness, or major environmental change. (Craig Kinsley, PhD and Elizabeth Meyer, PhD, Behavioral Neuroscience, October 2010)

I was sharing with a friend recently about the hidden gift of humility in needing to slow down on my desired accomplishments due to being a Mommy. She replied, “You are doing and growing more than most people I know, with or without children.”

“Oh,” I thought, “it certainly doesn’t feel like that.” I often tell my clients, who are recovering from eating disorders, that they are growing much faster than they realize. As they say in twelve-step recovery “You can’t kiss your own ear.” In other words, others will see your growth before you do. I certainly see that in my son. Sometimes it seems as if he has literally grown overnight. One day he is standing by the couch scooching, and then BAM! He is walking. One day he is babbling incoherently and then Bam! He is saying “Bump!” for Mr. Bump, and banging his chest for the gorilla. Where did my newborn go? And so, as I begin to let go of my Mommy brain fuzz (Hooray!!!), I am also letting go of my little breastfeeding baby (sweet sadness), toddling about, developing his own cerebral cortex and synaptic formations. (http://main.zerotothree.org/site/PageServer?pagename=ter_key_brainFAQ#changes) May the growth continue.

Linda Shanti McCabe, PsyD, works at the Association of Professionals Treating eating Disorders in San Francisco. You can learn more about her at http://WWW.DrLindaShanti.com